Physicians associated with Kansas and Missouri hospitals received about $46 million in payments from drug and medical device companies in 2014, with about 9 percent going to providers in the Kansas City area.

As the Rev. Susan McCann stood outside a public library in Springfield, Mo., last year, she did her best to persuade passers-by to sign an initiative to ban high-cost payday loans. But it was difficult to keep her composure, she remembers. A man was shouting in her face.